Daily Health Policy Report

Monday, February 13, 2012

Last updated: Mon, Feb 13

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Campaign 2012

Health Reform

Coverage & Access

Health Care Marketplace


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Experts Question Medicare’s Effort To Rate Hospitals’ Patient Safety Records

Kaiser Health News reporter Jordan Rau, in collaboration with The Washington Post and The Boston Globe, writes: "Medicare’s first public effort to identify hospitals with patient safety problems has pinpointed many prestigious teaching institutions around the nation, raising concerns about quality at these places but also bolstering objections that the government’s measurements are skewed" (Rau, 2/12). Read the story.

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FAQ: The Obama Administration's Compromise On Contraception Benefits

Kaiser Health News reporter Mary Agnes Carey writes: "The Obama administration, stung by fierce opposition from Catholic leaders to a new rule requiring that insurance plans offer free contraception, announced it is revising the regulations so that religious-affiliated groups don’t have to pay for the coverage. But President Barack Obama insisted that all women must still be covered" (Carey, 2/10). Read the story.

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Political Cartoon: "Principal Contraception Principle?"

Kaiser Health News provides a fresh perspective on health policy developments with "Principal Contraception Principle?" By Steve Kelley, New Orleans Times-Picayune

Meanwhile, here's today's health policy haiku:

Mandate in place, and
Mitt's unapologetic.
Primaries go on.
-- Jared M. Rhoads

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Administration News

Tax Increases, Medicare Cuts Expected In Obama Budget

President Obama will release his budget plan Monday, which is already getting its share of Republican detractors. In it, Obama will propose tax increases on the wealthy and $360 billion in cuts to Medicare and Medicaid, mostly in the form of payment cuts to providers and drug companies.

The Wall Street Journal: Budget Sets Stage For Year-End Clash
President Barack Obama's budget plan, to be released Monday, will serve both as an outline of his re-election campaign message and a blueprint of the White House strategy for another clash looming after the November elections. At year's end, the president and Congress face several major deadlines: the scheduled expiration of Bush-era tax cuts, $1.2 trillion in politically unpopular spending cuts — half of which would fall on defense spending — and the likely need to raise the federal borrowing limit. Medicare doctors also will face a large pay cut if Congress doesn't change the formula for their payments. ... Mr. Obama's budget plan will offer an alternative course: replace the scheduled year-end spending cuts with a combination of tax increases on the wealthy and some modest reductions to Medicare and Medicaid (Paletta and Meckler, 2/13).

The Washington Post: Jacob Lew Defends Obama's Spending Plan
White House Chief of Staff Jacob J. Lew on Sunday dismissed Republican criticism of President Obama's latest spending plan, arguing that it charts a long-term strategy for tackling the national debt while offering a short-term boost to the recovering economy. ... An additional $360 billion would come from trimming spending on federal health programs, such as Medicare and Medicaid, the biggest drivers of future borrowing. Those savings would come primarily from cuts to providers, including drug companies, rather than the sort of broad restructuring that many analysts say will be necessary to control costs. House Budget Committee Chairman Paul Ryan (R-Wis.) has criticized Obama for failing to offer a long-term cost-control strategy, such as his proposal to privatize Medicare for future retirees, which has come under fierce attack by Democrats (Montgomery, 2/12).

Los Angeles Times: Obama Budget Is Preview Of Election Battle
House Republicans are expected to offer a budget that renews their call for a major overhaul of Medicare, although it is not clear whether they will endorse the voucher program proposed last year by House Budget Committee Chairman Paul D. Ryan (R-Wis.). ... But the president's budget, like his previous proposals, steers clear of major changes. Ryan's Medicare proposal became a forceful weapon for Democrats last year, and many lawmakers on Capitol Hill have urged the White House not to undercut that issue. Obama's budget will repeat a call for $360 billion in reductions to Medicare and Medicaid, administration officials said, but avoid broader changes to the programs (Hennessey and Parsons, 2/13).

Politico: Obama's Budget Meant As Challenge
(T)he budget rollout in Washington will show a fourth year of $1 trillion-plus deficits and a 2013 shortfall of $901 billion — nearly twice the share of GDP that Obama predicted four years ago. The debate was already under way Sunday morning as White House chief of staff Jack Lew sparred across the television screen with House Budget Committee Chairman Paul Ryan, a Wisconsin Republican who at 42 is almost exactly the age Lew was when he oversaw the most recent balanced budgets in the 1990s during the Clinton administration (Rogers, 2/13).

Reuters: Obama Budget To Propose Election Year Spending On Jobs, Roads
President Barack Obama will project lower deficits and request billions of dollars for infrastructure and jobs in his 2013 budget, laying out a plan he will sell to voters in November, despite Republican criticism of rising federal debts. ... The budget must still spell out where the axe falls on domestic spending, with $360 billion expected to be saved by controlling growth in the costs of Medicare and Medicaid, federal health care programs for elderly and poor Americans (Bull and Bohan, 2/10).

The Associated Press: Obama's Budget Headed To Congress
President Barack Obama is sending Congress a new budget that seeks to achieve $4 trillion in deficit reduction over the next decade through cuts in government spending and higher taxes on the wealthy. ... The Obama budget seeks $360 billion in savings in Medicare and Medicaid mainly through reduced payments to health care providers, avoiding tougher measures advocated by House Republicans and the deficit commissions that said it was critical to restrain health care costs (Crutsinger, 2/13).

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Bishops, Congressional Republicans Vow To Fight New Contraception Plan

Meanwhile, insurers react cautiously to Friday's announcement.

The Wall Street Journal: Contraceptive Plan Still Draws Heat
At Masses across the country Sunday, Roman Catholic priests blasted the Obama administration's compromise on contraceptive insurance coverage, a sign the White House's backtrack late last week did little to defuse the controversy. The new policy requires religious employers such as universities and charities to cover contraception in employee health plans but shifts the responsibility for paying for it away from the employer and on to its health-insurance provider. Previously, the administration had required all employers apart from churches to cover contraception in their employee-insurance plans (Adamy, 2/13).

Politico: Why Dems Keep Stepping On Health Care Landmines
Somehow, the Democrats just can’t seem to keep reproductive politics from hijacking the health care debate. They almost lost the health reform bill a couple of times over abortion, as anti-abortion Democrats came close to derailing the bill during the 2009 House debate and then again during the final passage in 2010. ... It’s a predictable fight, and Democrats have always had to find ways to navigate the divide as they push to expand health coverage. But lately, some Democrats say, the Obama administration and party leaders haven’t been listening to the other side as well as they used to (Nather, 2/10).

The Associated Press: Analysis: Obama's Course Correction Shifts Dynamic
The once formidable coalition against the president had splintered. Factions that had stood with the GOP cautiously backed Obama's midcourse correction. It was a necessary policy change that reversed the political dynamic (Cassata, 2/11).

Kaiser Health News: FAQ: The Obama Administration's Compromise On Contraception Benefits
Some 28 states have mandated coverage of birth control, and 20 of those have some sort of exemption for religious employers. According to a report by the Guttmacher Institute, the state exemptions range from very narrow definitions, such as only for churches, to broader exemptions, including religious elementary and secondary schools. The most expansive state exemptions allow religiously-affiliated colleges and hospitals not to provide birth control coverage (Carey, 2/10).

Los Angeles Times: Key Republican Promises Fight Over Birth Control Coverage
Senate Minority Leader Mitch McConnell (R-Ky.) vowed Sunday to fight the administration's requirement that insurers provide contraceptive coverage for faith-based employers. McConnell said on CBS' "Face the Nation" that he would press legislation to exempt all employers from providing insurance coverage for contraceptives if they have religious or moral objections (Savage, 2/12).

The Sacramento Bee: Feinstein Regrets Obama's Birth Control Compromise
U.S. Sen. Dianne Feinstein expressed disappointment Saturday in the compromise the Obama administration announced this week on its birth control coverage mandate but said the decision "can be lived with." … Feinstein's comment contrasted with remarks made by House Democratic leader Nancy Pelosi, who defended the administration's move (Van Oot, 2/12).

San Francisco Chronicle: Nancy Pelosi Backs Obama's Birth Control Policy 
Pelosi, a practicing Catholic and mother of five, strongly praised Obama for "showing leadership in a very unifying way," and "for his ongoing commitment to women's health” (Marinucci and Garofoli, 2/11).

Reuters: White House Sticking To Contraception Plan
President Barack Obama will not make any more changes to the rule ... "We put out the plan that reflects where the president intended to go. This is our plan," White House chief of staff Jacob Lew said on CNN's "State of the Union" on Sunday (Frank and Kuo, 2/12).

The Washington Post: U.S. Bishops Blast Obama's Contraception Compromise
"The only complete solution to this religious liberty problem is for [the U.S. Department of Health and Human Services] to rescind the mandate of these objectionable services," the conference said in a statement released late Friday.  ... An administration official not authorized to speak on the record expressed little surprise at the bishops’ statement, which if anything represents a hardening of their position. “We never anticipated that this announcement would win the endorsement of an organization that opposed health reform from the very beginning,” the official said (Brown, 2/11).

Modern Healthcare: Shift On Birth-Control Coverage Gets Mixed Reaction
News that the Obama administration would accommodate faith-based employers who object to paying for health insurance that covers contraceptive services was welcomed by the head of the Catholic Health Association, while the insurance industry trade group greeted the announcement with caution (Zigmond, 2/10).

CBS News: Insurers Respond Cautiously To Contraceptive Plan
America's Health Insurance Plans focused its statement on concerns about the precedent President Obama's announcement may create: "Health plans have long offered contraceptive coverage to employers as part of comprehensive, preventive benefits that aim to improve patient health and reduce health care cost growth. We are concerned about the precedent this proposed rule would set" (Levin-Epstein, 2/10).

NewsHour (Video): Sebelius Explains White House’s Contraception Compromise
RAY SUAREZ: You say money from the religious institutions doesn't pay for this, but isn't money fungible? ...
KATHLEEN SEBELIUS: Well, again, Ray, in this case, actuaries have looked at this benefit. The federal employees health plan, when contraception was added to federal employees' benefit, which is the largest employee group in the country, costed this as no cost, free, no cost, because adding contraception and having some employees take advantage of that coverage lowers the overall cost of the health plan (2/10).

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Mich. Attorney General To Sue Adminstration On Birth Control Rule

While officials at some hospitals and universities expressed support for Obama administration's compromise last week, other religious and governmental leaders remained unsatisfied, according to media reports. 

Detroit Free Press: Michigan To Take Lead In Lawsuits Against Obama's Birth Control Mandate In Health Care Plans
Michigan Attorney General Bill Schuette said the state will take a lead effort in lawsuits against the Obama administration's mandate that most employers must include birth control coverage in their health plans. Saying that religious liberty is under attack, Schuette announced Thursday plans to make Michigan the lead state in filing briefs in support of lawsuits filed by the Becket Fund for Religious Liberty, a group that leans conservative and fights for religious rights (Warikoo, 2/10).

The Texas Tribune: In Texas, Reactions to Birth Control Compromise Mixed
Seton Healthcare Family, a major nonprofit Texas hospital system that provides health care to 1.8 million people, and had been vocally opposed to the original rule, expressed initial support for the compromise. ... “[The Texas Association of Business] has never taken a position on pro-life and pro-choice issues, but we do take a position against health insurance mandates,” said Texas Association of Business President and CEO Bill (Heinrich, 2/10). 

Des Moines Register: Obama Insurance Change Doesn't Satisfy Catholics
"The government can’t be about engineering who we are and what we are going to believe,” said [Des Moines Catholic Bishop Richard Pates] ... But Connie Ryan Terrell, executive director of the Interfaith Alliance of Iowa, said ... "We can’t as a nation be in the position of having a single religious perspective dictate public policy," said Terrell, who supports the administration’s mandate. Andy McGuire, the president of Meridian Health Plan and a one-time Democratic candidate for Iowa lieutenant governor, said she’s sympathetic to Terrell’s assessment, despite being a practicing Catholic (Erzen, 2/10).

Denver Post: Obama Broadens Exemption For Religious Groups, But Keeps Contraception Option For Their Employees
The arguments are more than an abstraction in Colorado, where Catholic-based organizations employ thousands of people from many faiths, at hospitals, nursing homes and other institutions. Centura Health operates one of the largest hospital systems in the state, as a partnership between Catholic Health Initiatives and the Adventist hospital system. Centura has nearly 6,000 employees covered by its health plan. In 2010, Colorado lawmakers mandated contraception coverage in many insurance plans in the state, but that law does not cover self-insured plans like Centura's (Draper and Booth, 2/10).

The Seattle Times: No Big Changes Likely For Catholic Institutions Here
By most accounts, Obama's compromise policy, which could force commercial-insurance companies to bear some new costs, likely will bring little change to Catholic institutions in the state. For example, at Seattle University, a Jesuit Catholic university, two employee plans and student plans already include oral-contraceptive coverage "consistent with state law," said Gerald Huffman, vice president for human resources and university services. ... [there is] a state regulation requiring all insurance plans that cover prescription drugs to also cover contraceptives (Ostrom, 2/10).

New Orleans Times-Picayune: Gov. Bobby Jindal Says Obama Birth Control Dispute Exposed 'Inherent Flaw In Obamacare'
Jindal said the "bigger issue" was the way in which the health care law had given the government the power to make decisions that "really ought to be made by doctors and their patients." He added that it would distort the workings of the health care market (Tilove, 2/11). 

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Capitol Hill Watch

Lawmakers Facing Showdown On Payroll Tax, Medicare Bill

Politico: Tax Standoff Remains After Weekend Talks
A weekend of talks between the two top tax writers in Congress failed to bridge gaping partisan differences over the payroll tax cut package, increasing the odds of another Washington showdown ahead of an end-of-the-month deadline. Senate Finance Committee Chairman Max Baucus (D-Mont.) and House Ways and Means Chairman Dave Camp (R-Mich.) traded offers throughout the weekend in an attempt to cut a deal on extending the payroll tax holiday and jobless benefits for millions of Americans — along with avoiding a rate cut for physicians who treat Medicare patients (Sherman and Raju, 2/13).

The New York Times: Obama Faces Task of Selling Dueling Budget Ideas
In Congress, Democrats and Republicans continue to negotiate over a package that would extend a temporary two-percentage-point cut in workers’ payroll taxes through this year, along with unemployment compensation for those out of work for more than six months and a delay in a scheduled deep reduction in Medicare reimbursements to doctors. “I do believe this will be extended,” Representative Paul D. Ryan, the Republican chairman of the House Budget Committee, said on the ABC program “This Week.” The two sides are split over how to offset the cost of the package, but lawmakers who worked over the weekend reported making progress (Calmes, 2/12).

The Associated Press: Deadline Nears, Obama Wants Payroll Tax Cut Action
President Barack Obama is pressuring Congress to extend a payroll tax cut for the rest of the year as another deadline nears for Congress to act or see taxes go up for millions of working people. ... Lawmakers have made halting progress on legislation to extend the tax cut. The bill also would renew jobless benefits for the long-term unemployed and prevent doctors from a 27 percent cut in their Medicare payments. But the plan costs $150 billion-plus and lawmakers will have to find a way to pay for it (2/11).

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Campaign 2012

Examining Romney's 'Shift' On Birth Control Mandate, Other Campaign News

Mitt Romney's conservative credentials on birth control are examined through the lens of a Massachusetts state law similar to the birth control mandate President Obama has proposed. In other campaign news, Rick Santorum continues his "Romneycare" assault, and The Associated Press analyzes how Obama's birth control compromise affects the campaign.

The Wall Street Journal: Romney And Birth Control: A Shift
Mitt Romney has said the Obama administration is intruding on religious freedom by moving to require religious–affiliated employers to cover contraception services in their health insurance plans. When confronted with a similar law as governor of Massachusetts, Mr. Romney didn't raise objections on religious or moral grounds, say people who worked in his administration or in health care interest groups there. Rather, he viewed the contraception requirement more in economic terms, as only one of many costly "mandates'' that some believed were driving up the price of insurance and suppressing competition, according to these people (Nicholas, 2/13).

The Associated Press: Spin Meter: Gov. Romney Quiet On Birth-Control Law
Mitt Romney faulted President Barack Obama's original push to require church-affiliated employers to pay for birth control as an "assault on religion," but as Massachusetts governor, Romney was largely silent about a state law that required virtually the same contraceptive coverage. The Massachusetts law, which essentially mirrored Obama's proposal, was signed by Romney's predecessor in 2002, the year before he took office. Romney did not seek its repeal (LeBlanc, 2/11).

The New York Times: Romney's Path To 'Pro-Life' Position On Abortion
From the moment he left business for politics, the issue of abortion has bedeviled Mitt Romney. ... He tangled with President Obama last week over whether religiously affiliated hospitals should be required to provide free contraceptives — "abortive pills," Mr. Romney called them. ... The comments reflect Mr. Romney's evolution from abortion rights advocate to abortion foe; gone was any trace of the candidate for governor who, 10 years ago, answered a Planned Parenthood questionnaire by saying he backed "state funding of abortion services" under Medicaid (Stolberg, 2/11).

NPR: Health Care In Massachusetts: 'Abject Failure' Or Work In Progress?
Romney is now a GOP presidential contender, and that's made the Massachusetts universal health care law a political football. Romney's rival Rick Santorum recently called it "an abject failure." But "Romneycare," as Santorum and others call it, isn't controversial in its home state (Knox, 2/13).

The Associated Press: Santorum Plans Aggressive Strategy Against Romney
Santorum said the president's plan doesn't resolve the issue. He says many Catholic institutions are self-insured and those organizations will still be forced to pay for women's contraception despite their religious objections. "There's no compromise here. They are forcing religious organizations, either directly or indirectly to pay for something that they find is a deeply, morally, you know, wrong thing," Santorum, a Catholic, told NBC's "Meet the Press" (Peoples, 2/12).

The Associated Press: Analysis: Obama Pitches Middle While GOP Eyes Base
The dustup over contraception underscored President Barack Obama's political edge in working to attract independent voters without alienating his Democratic base. His Republican rivals are forced to keep emphasizing their conservative credentials to attract the right-leaning activists who dominate the nominating contests. It's a dynamic that usually plays out when a president seeks re-election without a primary challenger, and the other party fights to determine its nominee (Babington, 2/12).

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Health Reform

Shortage Of Primary Care Doctors Raises Concerns

As the administration moves toward implementation of the health law, officials are seeking to bolster the number of primary care doctors. Also, hospitals are concerned about a possible measurement that would grade their efforts on patient safety.  

The Washington Post: The Health Reform Law's Biggest Threat: 30,000 Too Few Doctors
On a chilly afternoon at a community clinic in Southeast Washington, three young doctors are busily laying the foundation for the health-care law’s success. ... They are primary-care residents at Children’s National Medical Center. A third of their class has more than $200,000 each in student loan debt. At the end of residency, they can stay in primary care and earn $29.58 an hour. Or they can specialize and make $74.45 an hour. ... The Obama administration — and, arguably, the American health-care system — desperately needs them to choose primary care (Kliff, 2/11).

Kaiser Health News: Experts Question Medicare's Effort To Rate Hospitals' Patient Safety Records
Medicare's first public effort to identify hospitals with patient safety problems has pinpointed many prestigious teaching institutions around the nation, raising concerns about quality at these places but also bolstering objections that the government's measurements are skewed (Rau, 2/12).

Meanwhile, one news organization offers a novel take on accountable care organizations.

WBUR's Commonhealth blog: Cartoon Solves Health Care Puzzler: What The Heck Is An ACO?
Ladies and gentlemen! Announcing a whole new film genre: Wonk Cinema!! And what we hope will be the first in a series of CommonHealth cartoons dedicated to helping people stay awake as they learn about important health care changes that affect their lives. Our first topic: "What the heck is an Accountable Care Organization?" (Goldberg, 2/10).

Earlier, related KHN story: FAQ On ACOs: Accountable Care Organizations, Explained (Gold, 10/21/11) 

And the Wall Street Journal looks at a provision of the health law that has already taken effect.

The Wall Street Journal: Preventive Tests Covered By Medicare
Thanks to the health-care law, Medicare now covers the full cost of an expanding list of preventive services. On Jan. 1, the private, federally subsidized Medicare Advantage plans that cover 25% of those in the federal health-care program began offering the same coverage. All Medicare recipients can now obtain almost two dozen preventive services without owing co-payments or deductibles, including mammograms, annual flu vaccines and an annual "wellness" examination (Tergesen, 2/12).

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Administration Brief Defends Medicaid Expansion

Reuters: Obama Administration Defends Healthcare Medicaid Law
Administration attorneys defended on Friday the part of President Barack Obama's healthcare law that expands the Medicaid program for the poor and disabled and said Congress has the power to set the terms under which it will disburse funds to the states. In a written brief filed with the U.S. Supreme Court, the attorneys disagreed with the argument by 26 states that have challenged the law that the Medicaid expansion was unprecedented and will impose a significant, onerous financial burden on the states (Vicini, 2/10).

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Coverage & Access

N.Y. Times Poll Finds Majority Of Americans Say Taxes Will Exceed Benefits

Two stories examine Americans' views of government benefits and safety net programs.

The New York Times: Most Expect To Give More Than They Receive, Poll Finds
A majority of Americans say they expect to pay more in federal taxes over their lifetime than they will ever receive in benefits from the government, according to a recent New York Times poll. At the same time, the taxes Americans pay today are not keeping pace with the growing costs of government. Medicare is the program projected to add the most to federal spending over the next decade, likely increasing the government's annual budget deficits. But only one in five Americans surveyed named Medicare as the fastest-growing benefits program (Kopicki, 2/11).

The New York Times: Even Critics Of Safety Net Increasingly Depend On It
There is little poverty here in Chisago County, northeast of Minneapolis, where cheap housing for commuters is gradually replacing farmland. ... Dozens of benefits programs provided an average of $6,583 for each man, woman and child in the county in 2009, a 69 percent increase from 2000 after adjusting for inflation. ... Older people get most of the benefits, primarily through Social Security and Medicare, but aid for the rest of the population has increased about as quickly through programs for the disabled, the unemployed, veterans and children (Applebaum and Gebeloff, 2/11).

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Health Care Marketplace

Supply of Childhood Leukemia Drug Nearly Exhausted

A medicine to treat children's leukemia is in such short supply that hospitals may run out within weeks; meanwhile, families of people with Alzheimer's disease are clamoring to use a skin-cancer drug after a promising study in mice.

The New York Times: Supply Of A Cancer Drug May Run Out Within Weeks 
A crucial medicine to treat childhood leukemia is in such short supply that hospitals across the country may exhaust their stores within the next two weeks, leaving hundreds and perhaps thousands of children at risk of dying from a largely curable disease, federal officials and cancer doctors say. Methotrexate is used to treat childhood leukemia and rheumatoid arthritis (Harris, 2/10).

ABC News: Critical Shortage Of Children's Leukemia Drug
President Obama issued an executive order in October 2011 to reduce the dire shortage. The order instructed the Food and Drug Administration to broaden reporting of potential drug shortages, expedite regulatory reviews that can help prevent shortages, and examine whether potential shortages have led to price gouging. The drug shortage has compromised or delayed care for some patients and may have led to otherwise preventable deaths (Salahi, 2/10).

The Wall Street Journal: Alzheimer's Families Clamor For Drug
In the wake of research suggesting a skin-cancer drug may have benefits in treating Alzheimer's disease, physicians and advocacy groups are getting a flurry of calls from patients seeking to use the drug off-label. The clamor underscores how urgently patients want solutions to the rising tide of Alzheimer's. But experts caution that more research is needed to determine whether the drug, bexarotene, is effective in humans at all, not to mention what the dosage should be (Wang, 2/11).

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Knee Replacements Double In 10 Years, Study Says

The Associated Press: Nearly 1 In 20 US Adults Over 50 Have Fake Knees 
More than 4 million Americans over 50 have artificial knees, according to a new study. ... "These data are sobering because we didn't know what an army of people we've created over the last decade," said study author Elena Losina, co-director of the Orthopedics and Arthritis Center for Outcomes Research at Harvard's Brigham and Women's Hospital. ... Artificial knees also wear out after a period of time, so as the operations are increasingly done on younger Americans, many will live long enough to almost certainly need a second or even third knee replacement (Tanner, 2/10).

ABC News: Knee Replacements Double in 10 Years, Study Says
Advances in technology and improvements in surgical techniques have made the surgery more successful in recent years, although patients run the risk of infections and scar tissue development after the surgery. The procedure requires several days in the hospital, weeks of rehabilitation and costs about $40,000 (Gann, 2/10).

USA Today: Baby Boomers' Demand, Expectations For New Knees Soar
Revisions are more costly, complicated and risky, the report notes. They cost about $27,000, compared with the original surgery (about $20,000) and are riskier and more complicated. Most are covered by insurance, according to the American Academy of Orthopaedic Surgeons. Losina says the report will help the nation grasp the "substantial health burden" posed by those with knee replacements. The principal diagnosis is osteoarthritis. Despite manufacturers' suggestions that some prosthetic joints will last 30-plus years, Losina says there are no studies to support those claims (Lloyd, 2/10).

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GAO Finds Big Disparities In Prices Of Some Medical Devices

News outlets examine a variety of health workplace issues, including a GAO report on medical device prices and efforts to get health workers vaccinated for the flu.

Minneapolis Star Tribune: Secrecy On Medical-Device Prices Hurts Buyers, GAO Says
Hospitals are paying widely varying prices for the same implantable medical devices, according to a new study that suggests that secretive sales agreements prevent many buyers from getting the best deals. The report from the U.S. General Accounting Office -- which turned up a difference of more than $8,000 for one cardiac device alone -- found that confidentiality clauses in sales contracts keep even the physicians who decide which devices to use in the dark about prices (Walsh, 2/11).

Modern Healthcare: Panel Suggests Health-Worker Vaccine Mandate
HHS' National Vaccine Advisory Committee approved a recommendation that health care employers that haven't achieved 90 percent influenza vaccination compliance after following other recommendations to boost flu vaccination rates "strongly consider" an employee requirement for flu vaccination (Barr, 2/10).

Also, the Miami Herald looks at a development in heart surgery.

The Miami Herald: Doctors Fixing Heart Valves Without Surgery
Heart surgery was once the only remedy for heart valve disease, but new procedures are being used or tested in South Florida that may provide options, particularly for ailing patients who are at high risk for surgery. …  As people get older, the aortic valve, which is tissue-paper thin, may start to get calcified, fibrotic and narrowed, and may start wearing out, he said. About 20 percent of people over age 75 have a problem with their aortic valve, and by age 80, almost one out of three people have problems. In the United States, there are 100,000 open-heart surgeries per year to replace the aortic valve, O'Neill said (Cordle, 2/12).

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States' Medicaid Spending On Target; Feds Deny Further Fla. Medicaid Privatization

A survey says most state Medicaid budgets are on target through a series of program changes. In the meantime, CMS has denied a Florida proposal to expand Medicaid privatization there.

Modern Healthcare: Medicaid Budgets Mostly On Target, But Uncertainty Looms
A survey of state Medicaid directors found a healthy majority were on budget, thought some states continue to try to restrain spending by the safety-net insurer to address shortfalls. California sought to require Medicaid copayments, a proposal that died this week when federal officials said no. Meanwhile, Washington state health officials have said Medicaid payments would stop for unnecessary emergency room visits. Such dramatic policy proposals underscore the strain on state budgets and Medicaid spending from the slow recovery (Evans, 2/10).

The Associated Press/Miami Herald: Feds Deny Part Of Fla. Medicaid Proposal
Republican lawmakers' quest to expand a Medicaid privatization program statewide was dealt a blow this week after federal health officials said the state could not impose $10 monthly premiums on Medicaid beneficiaries. The Centers for Medicare and Medicaid Services also denied the state's proposal to charge $100 co-pays for any non-emergency ER visits, according to a letter sent Thursday. ... Lawmakers passed the bills last year trying to rein in the Medicaid budget of more than $20 billion a year and increase accountability for providers (Kennedy, 2/11).

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State Watch

Hospitals: N.Y. Times Finds Aggressive Debt Collection Despite Charity Care Rules

The New York Times: Hospitals Flout Charity Aid Law
New York’s charity care system, partly financed by an 8.95 percent surcharge on hospital bills, is one of the most complicated in the nation, but many states have wrestled with aggressive debt collection by hospitals in recent years. Like New York, several passed laws curbing hospitals’ pursuit of unpaid bills, including Illinois, California and Minnesota. But a new study of New York hospitals’ practices and state records finds that most medical centers are violating the rules without consequences, even as the state government ignores glaring problems in the hospitals’ own reports (Bernstein, 2/12).

Associated Press/Houston Chronicle: NC High Court To Hear Case Of $14K Hospital Bill
The case of a man who was stuck with a $14,419 bill that he calls inflated and unreasonable after three days of care in a Charlotte hospital is going to be heard by the North Carolina Supreme Court. The case, scheduled to be heard by the state's high court on Monday, is upsetting officials at the state's major medical centers. ... The North Carolina Hospital Association and big hospital groups based in Durham, Asheville, Greensboro, Winston-Salem and Raleigh want the Supreme Court to rule against Talford and make it easy for them to collect overdue bills in court without a trial (Dalesio, 2/12).

The Dallas Morning News: Parkland Hospital In Dallas Violated More Than 50 Safety Rules, Monitors’ Report Says
Federally installed safety monitors found that Parkland Memorial Hospital violated more than 50 government health-care standards in recent months, jeopardizing patients through botched surgical procedures, medication errors and dozens of other flawed practices. Those findings are contained in the 270-page report that Parkland leaders are refusing to release to the public, according to people with knowledge of the document. The public charity hospital also has recently distributed internal bulletins, obtained by The Dallas Morning News, alerting the staff to safety practices designed to prevent such failures (Moffeit and Egerton, 2/11).

Georgia Health News: New Grady CEO Speaks -- On The Mission And The Money (Q&A)
Grady Memorial Hospital is the biggest safety-net hospital in the state, and faces formidable challenges financially, with a large portion of its patients being uninsured. ... [CEO John] Haupert took time Thursday for a wide-ranging interview with Georgia Health News on the hospital’s financial status, potential Georgia Medicaid changes, health care reform, and government funding such as the disproportionate share (DSH) program for hospitals that serve a large number of low-income patients (Miller, 2/12).

The Sacramento Bee: California's Mobile Hospitals Are Running Out Of Money And Time
In the heady days of the housing bubble when the median home price in California was $576,000 and the general fund enjoyed a surplus in 2006, the state spent $18.3 million on three mobile hospitals for use in massive emergencies. But in a time of austerity, Gov. Jerry Brown and lawmakers chose last year to eliminate the $1.7 million to refresh supplies and ensure that an army of workers can build a 200-bed hospital in less than three days. … The state has not once deployed the hospitals since buying them five years ago. That's a good thing, state officials note, since it means California avoided major calamities during that period (Yamamura, 2/13).

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State Roundup: Health Law Implementation in Alaska, Calif., Mental Health Funding Challenges

Alaska Public Radio: State Working To Implement Affordable Care Act Requirements
Alaska is one of several states suing to overturn the Affordable Care Act -- President Obama’s health care overhaul. But behind the scenes, state agencies are quietly working on implementing various requirements in the law. One of those requirements is an exchange, which will work kind of like Expedia, but for health insurance plans. While the state studies its options, a bill moving through the legislature would also establish an exchange (Feidt, 2/10). 

California Healthline: State Considers Coverage Mandates
The deadline to pass legislation left over from last year has come and gone, with single payer, insurance rate regulation and the basic health plan all temporarily halted. The next big legislative push is coming up fast, as all new bills for 2012 have to be introduced by the end of next week, on Feb. 24. A number of health-related laws recently were passed by the state Senate or Assembly. Many of them call for coverage mandates by health insurance providers (Gorn, 2/13).

California Healthline: Report Looks at SHOP Exchange Viability
The first series of forums put on by Small Business Majority went to small towns and cities across California to raise the notion of a business-specific health insurance exchange -- the Small Business Health Options Program, known as SHOP. The idea is to pool small business resources and buying power -- separate from the California Health Benefit Exchange's individual market -- so business owners can get a better, more financially stable option for health insurance (Gorn, 2/10).

The Sacramento Bee: Sacramento County Aims Mental Health Effort At Hard-To-Reach Groups
While every demographic group has mental health problems, certain groups tend not to seek treatment. Now, Sacramento County is using an infusion of state cash to try to close that gap locally. ... The Sacramento effort targets groups that data show tend not to either seek or stick with treatment: Latinos; Hmong, Vietnamese and Cantonese speakers; Slavic and Russian-speaking residents; youths transitioning from adolescence to early adulthood; older adults; African Americans; American Indians; and college-age youths (Rubenstein, 2/13).

Des Moines Register: Bill Would Alter Background Check Process For Care Centers
Iowa lawmakers are considering changes to the 14-year-old law requiring criminal background checks of nursing home workers. A bill that has the support of both state regulators and the nursing home industry would streamline the background check process. Currently, applicants for nursing home jobs undergo an online background check that takes only a few seconds. If that initial check turns up no evidence of past criminal activity — felonies, serious misdemeanors, aggravated misdemeanors and a few simple misdemeanors — or abuse, the applicant can be hired on the spot (Kauffman, 2/12).

Des Moines Register: Bills This Week Likely Will Differ On Mental Health Funding
Counties currently contribute about $125 million annually toward services for people with mental illnesses or disabilities. Those contributions are scheduled to end in July 2013 under a bill the Legislature passed last year to try to force an overhaul of the system. However, many proponents said they expected this year’s reform legislation to include a renewal of the county financing (Leys, 2/12).

Houston Chronicle: Mentally Ill Inmates May Go To State Hospitals Sooner
Dozens of mentally ill inmates locked up in the Harris County Jail could soon be headed to state hospitals after a judge ordered Texas to cut long admission delays. Routinely, there have been 400 inmates, including those with schizophrenia, in county jails across Texas, although state officials say the latest count is 270. They have been waiting an average of six months for a bed in one of 10 mental hospitals (Pinkerton, 2/12).

The Associated Press/MSNBC: Texas Prison Board Approves Health Care Contract
The Texas prison board on Friday approved a $46.8 million contract to lease a handful of beds at a hospital in Huntsville as part of a first-time move to secure offender health care services outside its traditional university health providers. The contract with Huntsville Memorial Hospital comes amid reluctance from the University of Texas Medical Branch to continue a nearly two-decade-long deal to provide prisoner health care because of what it has reported as unanticipated losses of tens of millions of dollars (Graczyk, 2/10).

The Miami Herald / (South Florida) Sun Sentinel: More Doctors Charging Extra For Services That Once Were Free
Want to see your doctor without an appointment? You may have to pay a little extra. Skip an appointment, ask the doctor to fill out a life insurance form, get a printout of your medical records — all those may cost you $10, $20 or more. In South Florida's extended weak economy, medical experts say a growing number of doctors are taking a lesson from airlines and banks by charging separate fees for services that used to be free (LaMendola, 2/12).

The Miami Herald: Heart Attack Network Saves Time, Lives
When you are having a life-threatening heart attack, time matters. That’s where the STEMI Network comes in. The network – made up of a dozen South Florida hospitals and six fire rescue departments – has streamlined the process for treating major heart attacks, driving down the cardiac emergency mortality rate in Miami-Dade to less than 1 percent (McGrory, 2/12).

The Sacramento Bee: 'Model' Dental Program Proves Painful For Kids
Almost two decades ago, the state made Sacramento County the testing ground for a new model of delivering dental care to poor children. Officials envisioned a managed care system that would control costs and improve children's ability to see a dentist. Today that model persists – but state data show that the county has consistently produced one of California's worst records for care (Weiner, 2/12).

The Seattle Times: Expanded Review Looking Into Why Madigan Closed PTSD Program
The Army surgeon general is looking into why Madigan Army Medical Center closed an intensive treatment program to help soldiers cope with post-traumatic-stress disorder (PTSD). At a congressional hearing last Wednesday, the Army surgeon general, Lt. Gen. Patricia Horoho, said the review was included in an ongoing investigation of PTSD diagnoses at Madigan. A PTSD rating can qualify a soldier leaving the Army for medical retirement, which brings considerable financial benefits (Bernton, 2/11).

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Editorials and Opinions

The U.S. Debates The Contraception Rule

A selection of opinions and editorials on the controversy surrounding the administration's regulation mandating insurance coverage for women of birth control.

Los Angeles Times: Contraception and Women's Rights — It's Still A Man's World
The Roman Catholic Church is dominated by men. So, for that matter, is Islam. And so are a number of Christian churches — the Mormon Church, for example. Which is why we find ourselves, in the 21st century, with these faiths — and the men who run them — dictating to women on that most vital issue: the health of their own bodies (2/10).  

The Washington Post: War On Birth Control
There is no constitutional infirmity in requiring religious institutions to follow the same insurance and labor regulations as other employers. ... New York, whose Catholic archbishop has railed so vehemently against the administration on this issue, already lives under the rule he decries — it's state law (Rachel Maddow, 2/10).

NPR: Contraception, Abortion: A Reminder That It's Not Just The Economy, Stupid
Still, one can't help but think that in the end, this is less about contraception and religious teachings and more about what some inside the GOP see as a winning issue, one that paints Obama as hostile to religion and religious freedom. ... One unanswered question is whether Catholics, who don't normally vote as a bloc, will see this as an issue to get excited about. The guess here is no (Ken Rudin, 2/13).

The Washington Post: Obama's Contraception Fig Leaf
 One big gap in the administration’s plan involves how to treat religiously affiliated institutions that are self-insured. In those situations, the employer pays an insurance company to administer the plan but bears the cost of medical care directly. The administration’s approach does not necessarily solve the problem for such entities (Ruth Marcus, 2/10).

The Washington Post: President Obama’s Win-Win Reversal On Contraception
It’s unfortunate that the White House, which was fully aware of the strong feelings on both sides of the issue, failed to reach this resolution before the outcry. That is especially true because one fallout from the episode has been ill-advised calls to provide protections to non-religious employers as well as to religious institutions. ... It would be impossible to administer. But it is part of the unfortunate whirlwind that the administration helped sow (2/10).

The New York Times: The Freedom to Choose Birth Control
 In response to a phony crisis over "religious liberty" engendered by the right, President Obama seems to have stood his ground on an essential principle — free access to birth control for any woman. That access, along with the ability to receive family planning and preventive health services, was at the foundation of health care reform. ... If a religious body does not like a public policy that affects its members, it is free to try to change it, but it cannot simply opt out of society or claim a special exemption from the law (2/10).

Fox News: Obama Birth Control Policy Shift And The Power Of The Pill
The issue is not whether contraception is available. The issue is who pays. ... This is not a controversy that will go gently into that good night. Tweaking the language of the dictate will not close the matter. And this is not about the pill. ... ObamaCare and all the forming tentacles of its coercive programs must be overturned to protect the freedoms we all rely on (Kristi Stone Hamrick, 2/10).

The New York Times: Beyond Pelvic Politics
The debates about pelvic politics over the last week sometimes had a patronizing tone, as if birth control amounted to a chivalrous handout to women of dubious morals. On the contrary, few areas have more impact on more people than birth control — and few are more central to efforts to chip away at poverty (Nicholas D. Kristof, 2/11).

The Washington Post: Contraception And The Cost Of Culture Wars
Some conservative Catholics still insist that the relief from regulation that Obama offered is not enough. I hope they reconsider, especially since the Catholic service providers most affected by the revised rule welcomed it (E.J. Dionne, 2/12).

The Wall Street Journal: Immaculate Contraception
Here's a conundrum: The White House wants to impose its birth-control ideology on all Americans, including those for whom sponsoring or subsidizing such services violates their moral conscience. The White House also wants to avoid a political backlash from this blow to religious freedom. These goals are irreconcilable.

USA Today: Obama's Contraception Retreat Is Not Enough
President Obama beat a smart, strategic retreat Friday on the combustible issue of which employers should be required to offer contraceptive services to their employees. Obama did what he should have done in the first place: broaden the religious exemptions to the administration's birth control mandate to cover Catholic institutions such as universities, hospitals and charities, not just churches. ... The policy shift is getting mixed reviews from Catholic organizations, and it leaves some knotty questions to be resolved (2/12).

Denver Post: Compromise Confuses The Issue
The Obama administration's newest "compromise" on the issue of religious freedom and ObamaCare is little more than a political gimmick designed to distract from what is at stake. Despite efforts to confuse the issue, the bottom line is the President's newly-revised mandate still tramples upon religious freedom (Rep. Doug Lamborn, 2/12).

Denver Post: A Compromise On Contraception
You can call President Obama's very public retreat on contraception and religious rights a compromise or a surrender. But, however you frame it, the important thing is that the president ended up doing the right thing. The place where religious freedoms and reproductive rights meet is often a political and constitutional minefield. And Obama stepped right into the middle of it last summer in announcing rules that employer-provided health insurance plans must include free birth control (2/11).

Arizona Republic: Feds Back Off From Church
It has become clear that the president did not anticipate the firestorm of outrage his decision to force contraception coverage would generate. As an ardent supporter of women's right to abortion and birth control — and, we must suppose, as a Protestant who is perhaps unfamiliar with the Catholic Church's unflinching commitment to the defense of human life — Obama's blinders on the issue may be understandable. A wee bit, at least. But as professional politician and scholar of the U.S. Constitution, to boot ... well, how he missed this oncoming train is a wonder (2/11).

The Seattle Times: The Role Of Faith In Health Care Delivery
It's one thing to say that because you're using private funds, you don't have to provide services that violate religious conscience. It's another to accept public money in a market situation where "customers" don't have free choice, and make that same assertion. In a perfect world, patients would have full knowledge of whether the system they choose is compatible with their religious experience and beliefs. But in practice, this doesn't happen (Monica Harrington, Deborah Oyer, and Kathy Reim, 2/10).

Boston Globe: Playing With Women’s Rights
Well, that was rather a dazzling piece of political theater. Last week’s brouhaha over insurance coverage for contraceptives should be up for some Tony Awards. What a production, complete with spectacular acting, and serious scenery-chewing. And the sets! How did they recreate the 1960s so convincingly? There was even that thrilling gun-going-off-in-the-third-act thing, but luckily nobody was seriously hurt: The president just grazed his own foot (Yvonne Abraham, 2/12).

Boston Globe: The 'Mad Men' Era Of Contraception
The "Mad Men" era is great TV. But who — besides Catholic bishops, Republican presidential candidates and, maybe, Joe Biden — wants to go back to it in real life? The Catholic Church and GOP turned back the clock when they attacked President Obama’s plan to require church-run hospitals and universities to offer employees health insurance that covers contraceptives. It was Ike and Mamie Eisenhower time, stretching forward into the era of an intern-bedding JFK, when entitled men kept women in their place and birth control out of their reach (Joan Vennochi, 2/12).

San Jose Mercury News: Women's Health Takes Another Political Hit
Obama's so-called compromise with the bishops announced Friday is absurd. He's pretending that nonprofit employees can go to their insurance companies and pick up contraceptives "for free." … The new policy also opens the door for any business operator who opposes contraception — or any other health service — for religious reasons to seek a similar exemption. It invites chaos. It is hypocritical for the U.S. Conference of Catholic Bishops to criticize the Obama administration for imposing its will on the church when the church is trying to impose its will on its employees, many of whom are not Catholic (2/10).

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Viewpoints: Rationing Health Care, Jindal And Hospitals, Romney Vs. Past

A selection of opinions and editorials from around the U.S.

Houston Chronicle: New Health Law Will Not Ration Medical Care
It is time to begin open discussions about how to deal with expensive, minimally effective, medical care with patients, families, professionals and ethicists and not the medical industrialists who gain from prolonging life at every expense. Declaring rationing the third rail doesn't help anyone. It is time to allow the Food and Drug Administration to set high bars for value (including both cost and effectiveness) in approving new drugs and devices, and to allow Medicare to consider cost in what it covers. Delaying these discussions is like kicking the can down the road in the deficit discussions - not helpful now or for future generations (Arthur Garson Jr. and Carolyn Long Engelhard, 2/10).

San Francisco Chronicle: Medical Research Funding Threatened
Progress like this doesn't happen by accident. It is made possible by a sustained federal investment in medical research, which funds breakthrough projects at UC Davis and research centers across the country….We all want to reduce the deficit, but slashing funding for the National Institutes of Health will only exacerbate our economic challenges and lead to further suffering. Let's not jeopardize our country's medical or economic health by recklessly cutting funding for medical research (Claire Pomeroy, 2/13).

New Orleans Times-Picayune: Gov. Bobby Jindal Vs. LSU Hospital Administrators
Gov. Bobby Jindal must be kicking himself. He has just discovered that LSU hospital administrators are "completely irresponsible" with public money. But these are the guys who enjoyed his vigorous support in ramming through plans to abandon Big Charity and rip out a huge chunk of New Orleans to build themselves a $1.1 billion medical center (James Gill, 2/12).

Boston Globe: Romney Can't Outrun Past
In the six years Mitt Romney has been running for president, the one thing he has been zealous about is convincing his party's faithful that he is not some crazy moderate from Massachusetts. You know, the kind of person who might support emergency contraception for rape victims. Or even worse, abortion (Adrian Walker, 2/13).

Boston Globe: In His Attacks On 'RomneyCare,' Santorum Paints A False Picture
The Massachusetts health plan is a work in progress. It has brought about major improvements in the coverage of citizens, without unduly raising costs. It’s popular with Bay State residents, and has been workable for Bay State employers. But now, while officials grapple with new proposals to reduce insurance premiums, this year’s Republican presidential candidates are flooding the airwaves with bogus assertions about Massachusetts’ "RomneyCare’" health plan (2/11).

iWatch News: This Just In, Insurers Required To Speak Plain English
Starting this fall, insurers and employers that offer health care benefits must provide us with more clearly written information about what their benefit plans cover and how much of our own money we’ll have to pay if we get sick, injured or, yes, pregnant. This is no small matter. Rumors had been circulating in Washington over the past several months that the administration would cave to the demands of the insurance industry’s trade organization that this requirement be gutted to the point of being meaningless for most Americans (Wendell Potter, 2/13).

Related, earlier KHN story: HHS Unveils Requirements For Consumer Insurance Labels (Jaffe, 2/9) 

Des Moines Register: There's A Lot Of Heavy Lifting To Be Done By The 2012 Legislature
Legislators voted last year to do away with a $125 million levy for mental health, effective July 1, 2013. Legislators say they did it to force action on a long-awaited overhaul of the mental-health system. Now, they're racing the clock to find enough money for mental health. The choice is to either reinstate the property tax — a political nightmare for some lawmakers — or have the state shoulder the entire cost at the expense of other programs (Kathie Obradovich, 2/11).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.